Epithelial Ovarian Tumors Research Articles

Bilateral Somatically Derived Germ Cell Tumors With 12p Gains Arising in High-grade Serous Carcinomas of the Ovary: A Case Report and Review of the Literature.

Epithelial ovarian neoplasms are commonly observed in older patients, while germ cell tumors (GCTs) typically present in young individuals. When GCTs are detected in patients over 35yrs old, they often have an associated epithelial component, a phenomenon known as somatically derived GCTs. We report a unique case of mixed GCT involving bilateral ovaries with a background of high-grade serous carcinoma, including a yolk sac tumor and choriocarcinoma in the mixed GCT component. Somatically derived GCTs are rare with only 45 cases of ovarian carcinoma with somatic yolk sac tumor reported to date. Pathologists face diagnostic challenges in identifying somatically derived GCTs, as they can mimic high-grade epithelial neoplasms. Somatically derived GCTs have poor outcomes, therefore, precise diagnosis is crucial for prognostic and therapeutic considerations.

Targeting Mitochondrial Cholesterol Efflux via TCF21/ABCA10 Pathway to Enhance Cisplatin Efficacy in Ovarian Cancer.

Cisplatin (DDP) resistance is one of the causes of treatment failure for ovarian cancer (OV). Mitochondrial cholesterol level was reported to be associated with OV chemoresistance. We found that ABCA10, a potential cholesterol transport protein, was highly expressed in ovarian tissues and downregulated in OV tissues. Our study aimed to explore TCF21/ABCA10 axis resistance to DDP therapy in ovarian cancer based on regulating mitochondrial cholesterol efflux. Thirty epithelial ovarian cancer tumors and thirty ovarian tissues from non-cancer patients were collected. Western blot and RT-qPCR were used to measure ABCA10 and TCF21 expression levels in these tissues, as well as in a human ovarian epithelial cell line (IOSE-80), OV cells (A2780 and SKOV3), and DDP-resistant OV cell lines (A2780/DDP and SKOV3/DDP). IOSE-80 cells were also infected with ABCA10 knockdown lentivirus to identify the most effective ABCA10 knockdown plasmid. Lentiviral infection was used to create ABCA10 knockdown, ABCA10 overexpression, and TCF21 overexpression anti-DDP OV cell lines. Cell proliferation was detected by CCK-8 and EDU staining, flow cytometry for apoptosis, MTT for metabolic activity, calcium-induced Cytochrome C release, and mitochondrial matrix swelling for mitochondrial function and Oil Red O staining for lipid accumulation. Cholesterol metabolism was evaluated by measuring mitochondrial cholesterol and cholesterol efflux. Protein concentration was determined using the BCA method. A dual-luciferase reporter assay confirmed TCF21's interaction with ABCA10. ChIP also verified this interaction. The mRNA level (P < 0.01) and protein level (P < 0.001) of ABCA10 were downregulated in cancer tissues of OV patients relative to normal ovarian tissues. Relative to human ovarian epithelial cells, ABCA10 expression was significantly downregulated in OV cells (P < 0.01) and even more significantly downregulated in DDP-resistant OV cells (P < 0.001). Compared to the group treated solely with DDP, the overexpression of ABCA10 significantly inhibited the proliferation of DDP-resistant OV cells (P < 0.01), markedly reduced the staining intensity of EDU in these cells (P < 0.05), and substantially accelerated apoptosis in DDP-resistant OV cells (P < 0.01).Overexpression of ABCA10 further accelerated Cytochrome C expression and mitochondrial matrix swelling in DDP-resistant OV cells compared to the DDP-alone group (P < 0.01). The addition of cholesterol reversed the decrease in lipid accumulation, the decrease in mitochondrial cholesterol levels (P < 0.05), and the increase in cholesterol efflux (P < 0.01) in DDP-resistant OV cells caused by overexpression of ABCA10. The transcription factor TCF21 was bound to the promoter of ABCA10. Overexpression of TCF21 significantly increased ABCA10 expression in DDP-resistant OV cells (P < 0.01) and increased cytochrome C expression in A2780/DDP (P < 0.05) and SKOV3/DDP (P < 0.01) cells, with accelerated mitochondrial matrix swelling in A2780/DDP (P < 0.01) and SKOV3/DDP (P < 0.001) cells, while knockdown of ABCA10 reversed these effects. Our study found that TCF21 boosts ABCA10 expression, which in turn reduces DDP resistance in OV cells by enhancing mitochondrial cholesterol efflux. This mechanism increases the sensitivity of DDP-resistant OV cells to DDP. Our findings will provide new therapeutic targets for the treatment of ovarian cancer.

Borderline tumours of the ovary: A 37-year experience at a tertiary referral centre.

Borderline ovarian tumours (BOT) are a common epithelial ovarian tumours. Typically diagnosed at an early stage with a good prognosis, many BOT are treated conservatively. Recurrence is common. This update to our last audit in 1997 represents one of the largest audits of BOT to date. All patients with BOT managed at 'the hospital' from 1984 to 2021 were included. Expert pathology review was available. There were 549 cases included. The recurrence rate was 5% (n = 29/549) with 1.4% (n = 8/549) undergoing malignant transformation. Three of the eight women who recurred as cancer died from their disease. Frozen section was predictive of histologic diagnosis in 92% (n = 55/60) of serous tumours (SBOT), but only 62% (n = 54/87) of mucinous tumours (MBOT). In MBOT where the appendix appeared normal intra-operatively, it was histologically benign in all cases (n = 63). In SBOT, the recurrence rate was 5/23 (22%), 12/52 (23%), 1/29 (3%) and 3% (P = <0.01) for unilateral cystectomy, unilateral oophorectomy ± cystectomy, bilateral oophorectomy, and bilateral oophorectomy with hysterectomy, respectively, as index procedure. In MBOT this correlated to 2/20 (10%), 3/93 (3%), 0 and 1/58 (2%), respectively. This study describes important information correlating first surgical procedure and fertility-sparing surgery to recurrence and malignant transformation. For all BOT subtypes, fertility-preserving surgery increased the risk of recurrence and hysterectomy was not superior to removal of both ovaries. In MBOT, frozen section is of limited utility and the macroscopically normal appendix is very unlikely to be anything but benign, if MBOT is the true histologic diagnosis.

Data mining of PubChem bioassay records reveals diverse OXPHOS inhibitory chemotypes as potential therapeutic agents against ovarian cancer

Focused screening on target-prioritized compound sets can be an efficient alternative to high throughput screening (HTS). For most biomolecular targets, compound prioritization models depend on prior screening data or a target structure. For phenotypic or multi-protein pathway targets, it may not be clear which public assay records provide relevant data. The question also arises as to whether data collected from disparate assays might be usefully consolidated. Here, we report on the development and application of a data mining pipeline to examine these issues. To illustrate, we focus on identifying inhibitors of oxidative phosphorylation, a druggable metabolic process in epithelial ovarian tumors. The pipeline compiled 8415 available OXPHOS-related bioassays in the PubChem data repository involving 312,093 unique compound records. Application of PubChem assay activity annotations, PAINS (Pan Assay Interference Compounds), and Lipinski-like bioavailability filters yields 1852 putative OXPHOS-active compounds that fall into 464 clusters. These chemotypes are diverse but have relatively high hydrophobicity and molecular weight but lower complexity and drug-likeness. These chemotypes show a high abundance of bicyclic ring systems and oxygen containing functional groups including ketones, allylic oxides (alpha/beta unsaturated carbonyls), hydroxyl groups, and ethers. In contrast, amide and primary amine functional groups have a notably lower than random prevalence. UMAP representation of the chemical space shows strong divergence in the regions occupied by OXPHOS-inactive and -active compounds. Of the six compounds selected for biological testing, 4 showed statistically significant inhibition of electron transport in bioenergetics assays. Two of these four compounds, lacidipine and esbiothrin, increased in intracellular oxygen radicals (a major hallmark of most OXPHOS inhibitors) and decreased the viability of two ovarian cancer cell lines, ID8 and OVCAR5. Finally, data from the pipeline were used to train random forest and support vector classifiers that effectively prioritized OXPHOS inhibitory compounds within a held-out test set (ROCAUC 0.962 and 0.927, respectively) and on another set containing 44 documented OXPHOS inhibitors outside of the training set (ROCAUC 0.900 and 0.823). This prototype pipeline is extensible and could be adapted for focus screening on other phenotypic targets for which sufficient public data are available.Scientific contributionHere, we describe and apply an assay data mining pipeline to compile, process, filter, and mine public bioassay data. We believe the procedure may be more broadly applied to guide compound selection in early-stage hit finding on novel multi-protein mechanistic or phenotypic targets. To demonstrate the utility of our approach, we apply a data mining strategy on a large set of public assay data to find drug-like molecules that inhibit oxidative phosphorylation (OXPHOS) as candidates for ovarian cancer therapies.Graphical

Giant serous cystadenomas encountered in clinical practice: A case series

Benign serous cystadenomas represent 16% of all ovarian epithelial neoplasms, and account for up to two-thirds of epithelial tumors of the ovary. They are commonly encountered after the 3rd decade of life and in the later decades, due to the slow growth nature over lifetime. These tumors may begin as small unilocular subcentimeter lesions, but may expand to fill the entire abdominal cavity. This may present with mass effect to surrounding tissues and organs, and lead to sequela of compartment syndrome of the peritoneal cavity. We present a case series of surgical evaluation and management of extremely enlarged serous cystadenomas of the ovary (&gt;30 cm) encountered in an atypical age presentation, with the first case involving a 19 year old who had a known 6 cm cyst four years prior, who presented to emergency room (ER) with gastrointestinal (GI) symptoms secondary to the tumors mass effect, imaging demonstrating a massive tumor, subsequently requiring surgical dissection. The second case demonstrates a 25 year old with known cyst (&gt;20 cm) two years prior who presented with even larger effect (close to 40 cm size) and worsening symptoms due to the tumors mass effect requiring removal. In both cases, patients presented to emergency room with acute symptoms, exploratory laparotomy was required for complete evacuation of lesion and for resolution of symptoms.

Aggressiveness evaluation of borderline serous ovarian tumors by analysis of Psammoma bodies present in cancer tissues using micro-FTIR spectroscopy

Borderline ovarian tumor is a type of tumor with generally low malignant potential. However, these tumors pose diagnostic challenges with benign and malignant epithelial ovarian tumors because the clinical symptoms are similar and investigation procedures for specific diagnosis are still debated. In addition, a small number of borderlines transform into high-grade serous ovarian carcinoma with a poor prognosis. Therefore, tools improving a better characterization of high-risk subtypes of borderline tumors to enable understanding of possible unfavorable evolution are essential for patients’ management. Psammoma bodies (PBs) are microcalcifications found both in serous epithelial ovarian cancer and serous borderline tumors with possible correlation with disease progressionIn this work, the chemical composition of PBs found in the tissues of borderline, high-grade and low-grade ovarian tumors was evaluated using micro-FTIR spectroscopy. Applying principal component analysis to spectral data, it was observed that among the borderline tumors analyzed (1-bl,2-bland3-bl), the PBs of3-blshowed a different chemical content from that of the PBs of the high-grade and low-grade tumors, while the PBs of1-bland2-blappeared to have similar chemical content to the PBs of high- and low-grade tumors. The discriminating wavenumbers were found to be those related to carbonate CO32− (1454, 1413 cm−1and 872 cm−1) and phosphate PO43−(1018 cm−1and 960 cm−1) present in microcalcifications. A higher ratio between peak intensities at 1413 cm−1and 1018 cm−1(I1413/I1018) was observed in the PBs of3-blcompared with those of high- and low-grade ovarian carcinoma patients, which correlates with higher CO32− content. On the other hand, the PBs of1-bland2-blshowed a CO32−level close to that of the PBs of high- and low-grade patients. Several studies on microcalcifications in breast carcinoma have reported that increased carbonate content is related to decreased tumor aggressiveness. Therefore, case bl-3 appeared to be the less aggressive. The results obtained from FTIR analysis were in agreement with histopathological tumor classification and molecular analysis for BRAFV600E. The FTIR technique could become a reliable tool for identifying borderline low- and high-risk tumors.

Fine Needle Aspiration Cytology of Ovarian Tumors With Histopathological Correlation: A Revisit to Borderline Category

Abstract Background: Borderline ovarian tumors (BOTs) comprise 15%–20% of all ovarian epithelial malignancies. The majority of them are serous tumors followed by mucinous tumors. Pre-operative cytological diagnosis plays an important role with histopathology being the gold standard. The present study aimed to assess the sensitivity, specificity, and diagnostic accuracy of cytology in the diagnosis of epithelial ovarian tumors with special emphasis on the cytologically borderline category. Materials and Methods: The present study was conducted in our institute over five years from January 2017 to December 2022. This was a retrospective study and included 92 patients with ovarian masses who were subjected to ultrasound-guided fine needle aspiration (FNA) as a preliminary diagnostic procedure. Cytology smears were examined and categorized as benign, borderline, and malignant. The sensitivity, specificity, and diagnostic accuracy were assessed considering histopathology as the gold standard. Results: In the present study, 92 ovarian FNA cytology were performed. Aspirates were adequate in all but 10 cases. Out of 82 cases, 75 were epithelial tumors. Twelve cases of BOTs were compiled and cytological findings were assessed. Conclusion: To conclude, diagnosis of BOTs on cytology is difficult, however, aspiration from multiple sites from the lesion, critical cytomorphological assessment, and cell-block preparation with immunocytochemistry/immunohistochemistry can overcome the pitfalls.

Пухлина Бреннера у жінок репродуктивного віку з ожирінням: клініко-морфологічний аналіз випадків із практики

Background. Brenner tumors are rare epithelial ovarian tumors, the incidence of which among all ovarian tumors ranges from 0.6 to 2%. Considering the rarity of the pathology and absence of specific clinical symptoms, the authors present an analysis of own cases from the practice of Brenner tumor. Purpose – familiarization of the medical community with the clinical and morphological features of Brenner tumor in obese women of reproductive age based on an analysis of own practice cases. Materials and Methods. A clinical and morphological analysis of cases from practice of Brenner tumor of different histological variants in obese women of reproductive age is provided. Results. In the first case, in patient V., 42 years old, with obesity, a morphological study of the surgical material was diagnosed a benign variant of the Brenner tumor in the left ovary, which clinically manifested by pain and was not diagnosed by ultrasound. In the second case, in patient G., 36 years old, with obesity, it was morphologically diagnosed a benign variant of Brenner tumor in the right ovary, and borderline variant of Brenner tumor in the left ovary against the background of a benign variant. Brenner tumor in patient G. manifested by pain, infertility in anamnesis, and the presence of cysts on ultrasound examination. The menstrual cycle disorders in women in both cases may be caused by the presence of leiomyomas in the uterus or Brenner tumors or a combination of these tumor pathology. Conclusions. Brenner tumors are rare epithelial ovarian tumors, the only diagnostic method for which is a morphological examination of surgical material. Literature data about the role of obesity in the genesis of the development of these epithelial ovarian tumors, the presence in the described cases from practice of an increased body mass index in women with benign and borderline variants of Brenner tumors actualize the conduct of complex morphological studies in order to search, firstly, the etiopathogenetic features of the development of these ovarian tumors in obese women, and secondly, the morphological differential diagnostic criteria for these epithelial ovarian tumors in women with and without obesity.

The application value of two-dimensional ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of benign, borderline, and malignant ovarian epithelial tumors

ObjectiveThe aim of this study was to explore the clinical application value of two-dimensional ultrasound (2D-US) combined with contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of benign, borderline ovarian tumors (BOTs), and malignant ovarian epithelial tumors (OETs).MethodsThe clinical data of 108 patients who underwent surgery for pathologically confirmed of OETs at Peking University People’s Hospital between December 2018 and November 2023 were retrospectively studied. The diagnostic value of 2D-US combined with CEUS for diagnosing OETs was analyzed using chi-square tests, receiver operating characteristic (ROC) curves, and random forest models.ResultsAmong the 108 cases of OETs, 23 were benign, 34 were BOTs, and 51 were malignant. Chi-square tests confirmed that the perfusion pattern of the contrast agent plays an important role in the differential diagnosis of OETs. Compared with those in the benign group, the BOTs were not significantly different in terms of perfusion phase and enhancement intensity, but the regression time of the BOTs was earlier (P < 0.05). Compared with the BOTs, the malignant tumors group showed earlier perfusion and higher enhancement intensity, with no significant difference in regression time. The ROC curve results indicated that the combined diagnostic efficiency of 2D-US and CEUS in distinguishing OETs was significantly higher than that of a single diagnostic technique in terms of sensitivity, specificity, accuracy, and AUC. The random forest model results revealed that among the various parameters used in the differential diagnosis of OETs, the perfusion pattern was the most significant factor.Conclusion2D-US combined with CEUS helps improve the differential diagnostic efficiency for benign, BOTs, and malignant OETs.

Molecular alterations in mucinous ovarian tumors – a review

Abstract Mucinous ovarian tumors (MOTs) include primary and secondary neoplasms, the latter of which contribute for 80% of all cases. The most common site of origin for secondary MOTs is the gastrointestinal tract. Proper differentiation between primary and metastatic lesions is essential for effective treatment. Currently, definitive diagnosis is made based on post-operative histopathological examination with the use of immunohistochemical markers. However, the final diagnosis presents a challenge because of the histopathological similarity between mucinous metastases and primary ovarian lesions. Generally, treatment consists of cytoreductive surgery and adjuvant chemotherapy, even though malignant tumors are found to be chemo-resistant. Prognosis depends on the type of the tumor, presence of metastases and patient’s general condition. Further research on the genetic background of MOTs is necessary for the better understanding of their origin and more effective treatment. This review aims to summarize recent advances in the field of the molecular features of MOTs and their implications for the diagnostic pathways and potential adjuvant therapy options. The analysis of molecular alterations might not only be an important prognostic factor, but also a useful diagnostic tool in distinguishing between primary mucinous tumors and extra-ovarian metastases or other subtypes of epithelial ovarian neoplasms. Moreover, the examination of genetic mutations seems to increase the efficiency of targeted therapy. However, more research evaluating such therapies in pre-clinical models is needed to improve the results of the diagnostics and treatment of MOTs.

Mucinous Carcinoma of Ovary in a 15-Year-Old Girl, A Rare Case Report and Literature Review.

Ovarian epithelial tumors are common in adults, and the median patient age at presentation is 55 years. In children, epithelial tumors are rare and mostly benign. Mucinous cystadenocarcinoma is reported in only 11 cases less than 15 years old. This report describes the case of a 15-year-old postmenarchal Omani girl with ovarian mucinous carcinoma. She was admitted with severe epigastric pain and abdomen distension. CT scan showed a huge cystic lesion arising from the left adnexa filling the entire abdominal and pelvic cavity. The patient underwent laparotomy with left ovarian cystectomy and omental biopsy which revealed a 35 x 30 cm left ovarian cyst filled with turbid straw color fluid. Histopathology was reported as mucinous carcinoma. The patient later underwent cytoreductive surgery with left salpingo-oophorectomy, omentectomy, appendicectomy, and lymph node dissection that were negative for malignancy or metastatic disease. During follow-up, she developed a lymphocele in the pelvic cavity that was drained. There were no other significant issues during follow-up, as well as no evidence of recurrence or metastasis. Epithelial tumors of the ovary are rare in young girls, with malignant tumors being exceedingly rare. Fertility-sparing surgery is adopted over radical surgery in these patients, even though the recurrence rates with this treatment protocol are high. All cases should be under follow-up to look for recurrence and timely management.

Correlation of PD-L1 expression with different clinico-pathological and immunohistochemical features of ovarian surface epithelial tumors.

Primary carcinoma of the ovary (OCs) are responsible for a significant number of deaths related to cancer, and have the highest rate of death related to cancers of the female reproductive organs. Programmed cell death 1 (PD1) protein, acts as an immune checkpoint, and has an important role in the down-regulation of the immune system by preventing the activation of T-cells, which will weaken the autoimmunity and increases self-tolerance. This study aimed at the evaluation of the immunohistochemical (IHC) expression of PD-L1 in various primary surface ovarian epithelial tumours and to test its correlation with different clinicopathological parameters together with the expression of a panel of P53, ER and PR. A set of 102 cases of primary ovarian surface epithelial neoplasms (benign, borderline and malignant) were collected to construct Tissue Microarray (TMA) using 3 tissue cores from each case. IHC for PD-L1, p53, PR and ER was performed. The expression of PD-L1 was evaluated in relation to some clinicopathological parameters and to the expression patterns of other markers. Expression of PD-L1 was detected in about 51% (n = 36) of malignant tumours. The malignant group significantly showed PD-L1 positivity compared to borderline and benign groups. The malignant tumours significantly showed PD-L1 and total p53 positivity in comparison to borderline group. Also, malignant tumours significantly showed higher combined positivity of PD-L1 and either PR or ER compared to borderline and benign lesions. No significant correlation was appreciated between PD-L1 expression and with any of the studied clinicopathological parameters. This study showed a significant PD-L1 expression in malignant primary surface epithelial tumours. Construction of a panel of IHC markers, including PD-L1, could have a potential value to define patients those would benefit from the addition of immunotherapy to the treatment plan.

Changes in the tumour microenvironment mark the transition from serous borderline tumour to low-grade serous carcinoma.

Low-grade serous ovarian carcinoma (LGSC) is a rare and lethal subtype of ovarian cancer. LGSC is pathologically, biologically, and clinically distinct from the more common high-grade serous ovarian carcinoma (HGSC). LGSC arises from serous borderline ovarian tumours (SBTs). The mechanism of transformation for SBTs to LGSC remains poorly understood. To better understand the biology of LGSC, we performed whole proteome profiling of formalin-fixed, paraffin-embedded tissue blocks of LGSC (n = 11), HGSC (n = 19), and SBTs (n = 26). We identified that the whole proteome is able to distinguish between histotypes of the ovarian epithelial tumours. Proteins associated with the tumour microenvironment were differentially expressed between LGSC and SBTs. Fibroblast activation protein (FAP), a protein expressed in cancer-associated fibroblasts, is the most differentially abundant protein in LGSC compared with SBT. Multiplex immunohistochemistry (IHC) for immune markers (CD20, CD79a, CD3, CD8, and CD68) was performed to determine the presence of B cells, T cells, and macrophages. The LGSC FAP+ stroma was associated with greater abundance of Tregs and M2 macrophages, features not present in SBTs. Our proteomics cohort reveals that there are changes in the tumour microenvironment in LGSC compared with its putative precursor lesion, SBT. These changes suggest that the tumour microenvironment provides a supportive environment for LGSC tumourigenesis and progression. Thus, targeting the tumour microenvironment of LGSC may be a viable therapeutic strategy. © 2024 The Pathological Society of Great Britain and Ireland.

Pan-cancer analysis reveals GGPS1 plays an important role in tumorigenesis in multiple tumor types

The deletion of geranylgeranyl diphosphate synthase 1 (GGPS1) has been reported to inhibit the proliferation of multiple cells. Although emerging evidence has demonstrated a correlation between GGPS1 and cancer, no pan-cancer analysis has been conducted to date. This study explored the potential tumorigenesis of GGPS1 using data from the cancer genome atlas human clinical database. GGPS1 expression was considerably upregulated at both the RNA and protein levels in several cancer types, especially in breast carcinoma (BRCA), (liver) hepatocellular carcinoma (LIHC/HCC) and lung adenocarcinoma (LUAD). Amplification is the most common form of genetic alteration observed in invasive BRCA, ovarian epithelial tumor and HCC. Additionally, elevated GGPS1 expression was markedly related to poor patient prognosis and overall survival in several cancer types including LIHC. GGPS1 expression was also linked to cancer-associated fibroblasts (CAFs) infiltration in several cancer types, such as BRCA and LUAD. Moreover, GGPPS-interacting proteins and GGPS1-correlated genes in cancers were functionally enriched in terpenoid backbone biosynthesis, steroid biosynthesis, and metabolic pathways. These results indicate that GGPS1 may play a role in promoting the tumorigenesis and tumor development, particularly in BRCA and LUAD, and may play a role in steroid biosynthesis and metabolic pathways.

Seromucinous tumors of ovary: A case series

Seromucinous neoplasms are new category of ovarian epithelial tumor in the 2014 revised World Health Organization classification. Surface epithelial neoplasms are the most common ovarian tumors. Based on the degree of stratification and the presence or absence of invasion, these epithelial proliferations are further divided into benign, borderline, and malignant categories. Benign tumors are divided into three subtypes: cystadenoma (cystic areas), cystadenofibroma (cystic and fibrous areas), and adenofibroma (predominantly fibrous sections). Serous adenofibromas are rare variant of serous surface epithelial tumors. They affect females between the ages of 15 and 65 and make up 1.7% of all benign ovarian tumors. Serous tumor with a solid, fibrous component is designated as serous cystadenofibroma in which both serous and mucinous components are closely intermixed. Seromucinous adenofibroma is a benign cystic neoplasm composed of glands and cysts lined by an admixture of bland mullerian type epithelium which includes ciliated, endocervical type mucinous, and endometroid. They have a characteristic prominent fibromatous hypocellular stroma which helps differentiate it from the commoner cystadenoma. Seromucinous borderline tumors is 10% -20% of all epithelial ovarian tumors. Develops in younger age, usually bilateral in upto 40%, associated with endometriosis. We discuss about four different cases of seromucinous tumor reported in our institute.

Endometrioid Carcinoma Four Years After Hysterectomy: A Rare Case Report

It is quite a fascinating case as we have recently experienced in Mugda Medical College Hospital, a tertiary level teaching hospital in Dhaka, Bangladesh, that a woman was diagnosed and treated for endometrioid adenocarcinoma four years after her vaginal hysterectomy had been done. Our patient was presented with abdominal pain for nearly 2 weeks along with nausea, vomiting and generalized weakness. Ultrasound evaluation revealed a complex pelvic mass (8.6cm × 4.9cm). Chest x-ray revealed a left sided pleural effusion, while CT scan of the abdomen revealed heterogeneously enhancing complex pelvic mass and mild ascites. After a clinical correlation with all the pathological investigations, the patient was advised for a core biopsy. Ultrasonogram guided core biopsy was done. Histopathological examination showed a malignant ovarian epithelial tumor. Then she underwent an interventional or surgical procedure, which included an exploratory laparotomy, bilateral salpingo-oophorectomy with bilateral pelvic lymph node dissection and infracolic omentectomy done under general anesthesia. The final histopathological examination of the removed mass showed an endometrioid adenocarcinoma (Grade 2). Meanwhile, she was referred for radiation therapy (both vaginal brachytherapy and external pelvic radiation) after the patient had recovered from surgery. We will discuss this case as a part of our clinical interest and continuing education for our clinicians and residents. Mugda Med Coll J. 2024; 7(1): 53-55

O-309 Safety and fertility potential of residual ovarian cortex surrounding borderline tumors in women of reproductive age

Abstract Study question How do borderline ovarian tumors (BOTs) at different oncological stages affect safety (presence of occult lesions) and quality of the ovarian reserve? Summary answer The ovarian follicle pool is decreased in women with BOTS, especially at younger age, and oncological safety is compromised in more advanced oncological stages. What is known already The clinical decision-making balancing the type of surgical treatment (radical or fertility-sparing) with the the risk of recurrence is still controversial for women diagnosed with BOTs at different oncological stages. The same is for the use of adjuvant techniques like oocyte or ovarian tissue cryopreservation to optimize the likelihood of fertility recovery. The prevalence of occult lesions in healthy-looking ovarian cortex, which may be managed by surgery or cryopreservation, has not been analyzed in all tumor types. Moreover, the status of the ovarian follicle pool may be affected by tumoral masses, making fertility preservation even more challenging in these patients. Study design, size, duration Multicentric retrospective study involving Cliniques Universitaires Saint Luc in Brussels (Belgium) and Macedonio Melloni hospital in Milan (Italy). Forty-two women at reproductive age (15-45 years) diagnosed with borderline ovarian tumors (BOTs), including 24 serous, 14 mucinous and 4 endometrioid BOTs were included. Participants/materials, setting, methods Histological samples of ovarian cortex surrounding tumors were analyzed to characterize the follicle pool (follicle density, classification and atresia rates) and results were compared with an aged-matched population of 45 subjects with non-ovarian pathologies. Any occult malignant lesions in healthy-looking cortex were investigated using tumor-specific markers (cytokeratin 7 and mucin 1), while immune system infiltration was quantified by CD3 for tumor-infiltrating lymphocytes (TILs) and CD68 for tumor associated macrophages (TAMs). Main results and the role of chance Occult ovarian lesions were observed in 5 out of 39 cases (12.8%). These included one mucinous stage-I BOT (1/13), one serous stage-I BOT (1/13), and 3 advanced-stage serous BOTs (3/11). Three 3 cases were excluded from the analysis because no cortex was available. Notably, follicle density was significantly lower in subjects diagnosed with ovarian tumors than in controls (p &amp;lt; 0.001) at a younger age, while no difference was detected in older patients. Significantly greater follicle atresia was encountered in the ovarian tumor group than in controls (20.1 ± 8.8% vs 9.2 ± 9.4%, p &amp;lt; 0.001) at all ages, but no difference was detected in follicle classification parameters (primordial and growing follicle rates). Mucinous BOTs exhibited lower follicle density than serous BOTs (98.8 ± 152.8 vs 225.8 ± 220.7, p &amp;lt; 0.01), although no age difference was evidenced. Although mucinous BOTS had also significantly bigger volume than serous BOTs, no significant correlation between follicle density and tumoral volume was found. Other factors like tumor microenvironment may play a role in ovarian follicle pool damage. Both TILs and TAMs were found in ovarian tumors irrespective of histotype, but no link was established with the status of the ovarian reserve. Limitations, reasons for caution Although this study helped to elucidate the risk profile of different types of epithelial ovarian tumors, observing that late-stage BOTs ran a 27% (3/11) risk of occult ovarian lesions, further research is needed to identify predictive markers. Wider implications of the findings Personalized counseling for fertility preservation is required in case of BOTs. Fertility-sparing surgery and adjuvant gamete preservation should be considered, balancing any oncological risks against tumor stage and histotype and fertility potential, especially at a younger age. Trial registration number NA

Mesonephric-type adenocarcinomas of the ovary: prevalence, diagnostic reproducibility, outcome, and value of PAX2.

Mesonephric-type (or -like) adenocarcinomas (MAs) of the ovary are an uncommon and aggressive histotype. They appear to arise through transdifferentiation from Müllerian lesions creating diagnostic challenges. Thus, we aimed to develop a histologic and immunohistochemical (IHC) approach to optimize the identification of MA over its histologic mimics, such as ovarian endometrioid carcinoma (EC). First, we screened 1,537 ovarian epithelial neoplasms with a four-marker IHC panel of GATA3, TTF1, ER, and PR followed by a morphological review of EC to identify MA in retrospective cohorts. Interobserver reproducibility for the distinction of MA versus EC was assessed in 66 cases initially without and subsequently with IHC information (four-marker panel). Expression of PAX2, CD10, and calretinin was evaluated separately, and survival analyses were performed. We identified 23 MAs from which 22 were among 385 cases initially reported as EC (5.7%) and 1 as clear cell carcinoma. The interobserver reproducibility increased from fair to substantial (κ = 0.376-0.727) with the integration of the four-marker IHC panel. PAX2 was the single most sensitive and specific marker to distinguish MA from EC and could be used as a first-line marker together with ER/PR and GATA3/TTF1. Patients with MA had significantly increased risk of earlier death from disease (hazard ratio = 3.08; 95% CI, 1.62-5.85; p < 0.0001) compared with patients with EC, when adjusted for age, stage, and p53 status. A diagnosis of MA has prognostic implications for stage I disease, and due to the subtlety of morphological features in some tumors, a low threshold for ancillary testing is recommended.

Epithelial Ovarian Tumor in a Streak Ovary: A Rare Entity in Turner Syndrome Managed by a Minimally Invasive Approach

Epithelial Ovarian Tumor in a Streak Ovary: A Rare Entity in Turner Syndrome Managed by a Minimally Invasive Approach

70P Tumor biomarkers contribute to the clinical management of the O-RADS MRI risk stratification system in epithelial ovarian tumors

70P Tumor biomarkers contribute to the clinical management of the O-RADS MRI risk stratification system in epithelial ovarian tumors